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[Mesenteric panniculitis]
H F Kienzle1, R Karim, A Recepoglu
1Kliniken der Stadt Köln, Chirurgische Klinik Krankenhaus Holweide.
Abstract:
We report three cases of mesenteric panniculitis in which the disease took different courses. The first case clinically mimicked an acute diverticulitis and consequently laparotomy was performed. During this operation a large space-occupying tumour was found in the lower abdomen. After resecting this tumour mass of uncertain classification (benign or malignant) a preternatural anus of sigmoid colon was formed. Histological exploration revealed mesenteric panniculitis. Six months later we restored continuity of large bowel by end-to-end anastomosis. No residues of the preexisting panniculitic alterations were seen. The second case concerned a female patient who again complained of discomfort after surgical treatment of colon carcinoma. We measured an elevated erythrocyte sedimentation rate and suspected a relapse of the malignant disease. Notwithstanding radiological and endoscopic diagnostics, the origin and classification of an intra-abdominal tumour could not be determined preoperatively. Laparoscopically we took a biopsy of the local mass, but a definite diagnosis was not found. Postoperatively undulant fever occurred, uninfluenced by cortisone treatment. Finally the patient died because of unstoppable hemorrhage under coagulopathy. Mesenteric panniculitis was identified as causative disease by autopsy.
Insights
Mesenteric panniculitis is a rare condition that can mimic other diseases, presenting diagnostic challenges. This report details three distinct cases, highlighting varied clinical courses and diagnostic difficulties in identifying this abdominal mass.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Mesenteric panniculitis is an idiopathic inflammatory condition affecting the mesentery.
- It can present as an abdominal mass, mimicking malignancy or other inflammatory processes.
Observation:
- Case 1: Presented with symptoms of acute diverticulitis, leading to laparotomy and resection of a space-occupying mass, later diagnosed as mesenteric panniculitis.
- Case 2: A female patient with a history of colon carcinoma developed an intra-abdominal mass, initially suspected as malignancy relapse. Diagnostic workup, including laparoscopy, was inconclusive. The patient ultimately died from hemorrhage and coagulopathy, with autopsy revealing mesenteric panniculitis.
- Case 3: (Not detailed in the provided abstract, but implied by the introduction of 'three cases')
Findings:
- Mesenteric panniculitis can present with diverse clinical manifestations and disease trajectories.
- Diagnostic challenges are significant, often requiring surgical intervention and histological confirmation.
- The condition can be mistaken for other intra-abdominal pathologies, including malignancy.
Implications:
- Increased awareness of mesenteric panniculitis is crucial for accurate and timely diagnosis.
- Differential diagnosis in cases of unexplained abdominal masses should include mesenteric panniculitis.
- Further research into the pathogenesis and optimal management strategies for mesenteric panniculitis is warranted.